mHealth for Schizophrenia: Patient Engagement With a Mobile Phone Intervention Following Hospital Discharge

• Published in: JMIR mental health 2016-07, Vol.3 (3), p.e34-e34
• Main Authors: Ben-Zeev, Dror, Scherer, Emily A, Gottlieb, Jennifer D, Rotondi, Armando J, Brunette, Mary F, Achtyes, Eric D, Mueser, Kim T, Gingerich, Susan, Brenner, Christopher J, Begale, Mark, Mohr, David C, Schooler, Nina, Marcy, Patricia, Robinson, Delbert G, Kane, John M
• Format: Article
• Language: English
• Subjects: Age; Cellular telephones; Demand curves; Intervention; Mental health; Original Paper; Patient compliance; Psychosis; Schizophrenia; Smartphones
• ISSN: 2368-7959; 2368-7959
• DOI: 10.2196/mental.6348

mHealth interventions that use mobile phones as instruments for illness management are gaining popularity. Research examining mobile phone‒based mHealth programs for people with psychosis has shown that these approaches are feasible, acceptable, and clinically promising. However, most mHealth initiatives involving people with schizophrenia have spanned periods ranging from a few days to several weeks and have typically involved participants who were clinically stable. Our aim was to evaluate the viability of extended mHealth interventions for people with schizophrenia-spectrum disorders following hospital discharge. Specifically, we set out to examine the following: (1) Can individuals be engaged with a mobile phone intervention program during this high-risk period?, (2) Are age, gender, racial background, or hospitalization history associated with their engagement or persistence in using a mobile phone intervention over time?, and (3) Does engagement differ by characteristics of the mHealth intervention itself (ie, pre-programmed vs on-demand functions)? We examined mHealth intervention use and demographic and clinical predictors of engagement in 342 individuals with schizophrenia-spectrum disorders who were given the FOCUS mobile phone intervention as part of a technology-assisted relapse prevention program during the 6-month high-risk period following hospitalization. On average, participants engaged with FOCUS for 82% of the weeks they had the mobile phone. People who used FOCUS more often continued using it over longer periods: 44% used the intervention over 5-6 months, on average 4.3 days a week. Gender, race, age, and number of past psychiatric hospitalizations were associated with engagement. Females used FOCUS on average 0.4 more days a week than males. White participants engaged on average 0.7 days more a week than African-Americans and responded to prompts on 0.7 days more a week than Hispanic participants. Younger participants (age 18-29) had 0.4 fewer days of on-demand use a week than individuals who were 30-45 years old and 0.5 fewer days a week than older participants (age 46-60). Participants with fewer past hospitalizations (1-6) engaged on average 0.2 more days a week than those with seven or more. mHealth program functions were associated with engagement. Participants responded to prompts more often than they self-initiated on-demand tools, but both FOCUS functions were used regularly. Both types of intervention use declined over time (o